DNS advice

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Hi everyone, looking for experienced DON/DNS advice. After survey now, QIS, lots of tags, one G, lots of attitude and pointing of fingers, difficult regional (at best prior to survey) now non-existant, suspect the end is near. What's a way to leave with some chance of getting another DON/DNS position. New to this job, interviews not going well, even in Assisted Living. Advice? (*how do I frame up bad survey, inexperienced staff, inexperienced DNS etcetc) without sounding like a disgruntled employee?

How long have you been with this current job? If it's not very long, you can often dodge the critical questions with "the job was a poor fit" or something in that vein. But whatever you do, never bash the company or blame your leaving on a specific person or persons---LTC is an incestuous environment where everyone knows everyone else's business only slightly better than they do their own, and it'll bite you in the arse if you complain about disorganized staff, a poor relationship with your regional, etc.

Wishing you the best in your search. I'm happy as a clam where I'm at these days, but I still remember what it was like to hold a job I loathed and be unable to find a decent way out of it.

How long have you been with this current job? If it's not very long, you can often dodge the critical questions with "the job was a poor fit" or something in that vein. But whatever you do, never bash the company or blame your leaving on a specific person or persons---LTC is an incestuous environment where everyone knows everyone else's business only slightly better than they do their own, and it'll bite you in the arse if you complain about disorganized staff, a poor relationship with your regional, etc.

Wishing you the best in your search. I'm happy as a clam where I'm at these days, but I still remember what it was like to hold a job I loathed and be unable to find a decent way out of it.

Thanks very much. New to the job just a few months. Interviews that I am going on, I can't make it not negative and I really don't know what to say, I might need to simply go back to the floor and work my way up again. But then... an administrator told me "Why AREN'T you applying for a managment position, with all your years in management?" Because I failed...?? I don't' know what the answer is...So overqualified (but new RN, was an LPN manager) for floor, failed as first time out as DNS, stuck?

It depends on what you want to do. I wouldn't say anyone is ever "stuck" in one niche unless they want to be. I've spent much of my career bouncing back and forth between management and the floor---been a DNS/DON or ADON, staff development coordinator, and RCM as well as a charge nurse---and never felt stuck in any of those roles.

Oh, and BTW, please don't say you've "failed" as a DNS. Your facility didn't give you the support you needed, and it's really difficult (if not impossible) to succeed in such a situation. Again, I say, the job was a poor fit, and you're better off out of it IMHO.

It depends on what you want to do. I wouldn't say anyone is ever "stuck" in one niche unless they want to be. I've spent much of my career bouncing back and forth between management and the floor---been a DNS/DON or ADON, staff development coordinator, and RCM as well as a charge nurse---and never felt stuck in any of those roles.

Oh, and BTW, please don't say you've "failed" as a DNS. Your facility didn't give you the support you needed, and it's really difficult (if not impossible) to succeed in such a situation. Again, I say, the job was a poor fit, and you're better off out of it IMHO.

Thanks very much for that comment, I really appreciate it. I don't truly think I failed, I think my facility fared far better for me being at the helm and you are very perceptive, NO support, lots of combative higher ups who apparently were pushing their own agendas. I agree, and I am looking forward to returning to the basics as a new RN, I will start a new job, on the floor, in a very respected facility with staff that know me from another job, and aren't concerned onthe DNS situation, and I welcome the change. It was impossible to have any other outcome, and I will continue interveiwing for SNF DNS and AL DNS. Yes, you are right,, "the job was a poor fit, I decided to move on". and then I don't have to answer silly questions. AND..our survey wasn't that bad, actually pretty good (three other buildings in this state were put in stop placement after their QIS survey, we were not...funny how I won't get credit for that, oh well. Everything happens for a reason. I am going back to get my masters, very excited to find out I can start in September and put this difficult building behind me. My staff are suffering as well, both RCM's put on 30 day action plans, both moving on as well. Sad...but welcome to LTC!

OKAY---YOU didn't fail. Surveys are a snapshot of the 3 or 5 or 21 days the state is in the building. We just got our 2567 (SOD) today and we were all dumbfounded. Last year we got 2 tags. This year, we gave far better care to far sicker residents, and we got, sit down for this.....29 tags. Do I feel I failed as the DNS? Not really. The survey team was nasty...didn't ask us any questions to clarify half of what they said we did wrong..the administrator told them he'd only been there for a few days and it was a horrible building.
I know survey is important, but really....at the end of the day if you think your residents were well cared for, that's okay.
The company I work for doesn't place blame on any one person or department. If there is a tag, it's a facility tag. Not all companies are like that, though so I can see where you're coming from.

OKAY---YOU didn't fail. Surveys are a snapshot of the 3 or 5 or 21 days the state is in the building. We just got our 2567 (SOD) today and we were all dumbfounded. Last year we got 2 tags. This year, we gave far better care to far sicker residents, and we got, sit down for this.....29 tags. Do I feel I failed as the DNS? Not really. The survey team was nasty...didn't ask us any questions to clarify half of what they said we did wrong..the administrator told them he'd only been there for a few days and it was a horrible building.
I know survey is important, but really....at the end of the day if you think your residents were well cared for, that's okay.
The company I work for doesn't place blame on any one person or department. If there is a tag, it's a facility tag. Not all companies are like that, though so I can see where you're coming from.

Count your blessings that you work in a supportive environment, and yep, surveyors are just plain nasty, there is no other way to describe it. I have to say that I have such a supportive team of co-workers and friends/mentors in the industry and it is thru my previous marketing/admissions community assisted living contacts that I am getting a great offer as a Charge RN in a well respected company (the big K...) and I am glad to be moving forward. Sad that a few days of survey can put a "new" company off, but everyone thinks this company is not long for staying in business, so far managed to fire any decent manager that tried to work there, for any number of reasons, and replaced with seriously impaired inexperienced staff.

OKAY---YOU didn't fail. Surveys are a snapshot of the 3 or 5 or 21 days the state is in the building. We just got our 2567 (SOD) today and we were all dumbfounded. Last year we got 2 tags. This year, we gave far better care to far sicker residents, and we got, sit down for this.....29 tags. Do I feel I failed as the DNS? Not really. The survey team was nasty...didn't ask us any questions to clarify half of what they said we did wrong..the administrator told them he'd only been there for a few days and it was a horrible building.
I know survey is important, but really....at the end of the day if you think your residents were well cared for, that's okay.
The company I work for doesn't place blame on any one person or department. If there is a tag, it's a facility tag. Not all companies are like that, though so I can see where you're coming from.

Yikes. I agree with every bit of your post...but to see 29 tags in writing still sucks the wind out of you for a bit. Several years ago when I was still stuck back in the MDS office we had a lousy DON. She spent most of the day out back smoking or on the units gossiping, never followed up on anything, never held anyone accountable for anything, etc. For a time the building went to hell. State walked in and I just knew we would get slammed. Wouldn't you know we had one of the best surveys in our history. I wanted to ask the surveyors what they were smoking because on any given day I could identify many tags without any effort. It really is just the luck of the moment and the mood of the surveyors.

I do have to say tho that I am not looking forward to my own first survey as DON. Would be scary just to have the old survey but a new job and a new survey process all within a few months. Holding my breath.

Yikes. I agree with every bit of your post...but to see 29 tags in writing still sucks the wind out of you for a bit. Several years ago when I was still stuck back in the MDS office we had a lousy DON. She spent most of the day out back smoking or on the units gossiping, never followed up on anything, never held anyone accountable for anything, etc. For a time the building went to hell. State walked in and I just knew we would get slammed. Wouldn't you know we had one of the best surveys in our history. I wanted to ask the surveyors what they were smoking because on any given day I could identify many tags without any effort. It really is just the luck of the moment and the mood of the surveyors.

I do have to say tho that I am not looking forward to my own first survey as DON. Would be scary just to have the old survey but a new job and a new survey process all within a few months. Holding my breath.

Unfortunately, all corporations are not supportive, no matter what the survey results are. We actually pulled off a decent survey, new management team, I as new DSN, NOT in stop placement like 4 other buildings, sureveyors are maxing out tags all over town, and DNS's getting fired right and left, and I manage, after only a few months as the leader, to pull off a decent survey...my company thanked me earlier this week by walking me out of the building ("inexperienced RN in key positions" "We are going in a different direction") and now, just for fun, they are doing it to all my RN nurse managers, so so sad. I feel so responsible, I talked all those folks into coming for the job, to work for me, and now....SO sad.

Unfortunately, all corporations are not supportive, no matter what the survey results are. We actually pulled off a decent survey, new management team, I as new DSN, NOT in stop placement like 4 other buildings, sureveyors are maxing out tags all over town, and DNS's getting fired right and left, and I manage, after only a few months as the leader, to pull off a decent survey...my company thanked me earlier this week by walking me out of the building ("inexperienced RN in key positions" "We are going in a different direction") and now, just for fun, they are doing it to all my RN nurse managers, so so sad. I feel so responsible, I talked all those folks into coming for the job, to work for me, and now....SO sad.

Oh, how heart breaking for you! It is hard but try not to take it personally.

I warned my family when I accepted this DON job (my first) that all to often I hear of DON's getting walked out the door for little to no reason. In my part of the country tho it is so odd how it doesn't seem to have any affect on future employment. It is so common that one can easily go down the road a day after being fired and get hired into a new DON position.

There is so much turnover in LTC that I'm always surprised when I visit a facility (to evaluate a prospective resident, or assess one of our own for his/her readiness to return home) and find the same management people I spoke with the last time I was in their building.

Right now I'm consulting in a sister facility whose survey was 118 typed pages of horror. Their nurse had only been on the job for 3 months when the surveyors came in, and they barbecued her---I'm actually amazed that she didn't quit. It's kind of sad that people come into AL nursing thinking "Oh for Pete's sake, it's assisted living, how hard can it be?" and then they FIND OUT how hard it is by getting skewered in the survey process. This particular nurse came from a home health/hospice background, so she really doesn't know what she's doing....and what's worse, there is no sense of urgency in working on the plan of correction on either hers or the facility administrator's part.

So now the VP of clinical operations, a DNS from another building, and I were going through the residents' charts, which are an unholy mess......while the nurse and the administrator BOTH were out doing move-in assessments. Really??! They aren't doing a decent job of caring for the residents they already have; I can't imagine the State allowing them to move anyone else in at this point. Not with med aides who leave the diabetic MARs in the med room while giving insulin because "I know all of their sliding scale insulin orders" and upgrade mechanical-soft diet textures to "regular" without either notifying the nurse or MD "because the resident wanted it". YAAAAAAAAAAAACCCCCCCCCCK!!!!

Oh, how heart breaking for you! It is hard but try not to take it personally.

I warned my family when I accepted this DON job (my first) that all to often I hear of DON's getting walked out the door for little to no reason. In my part of the country tho it is so odd how it doesn't seem to have any affect on future employment. It is so common that one can easily go down the road a day after being fired and get hired into a new DON position.

Yeah, its rampant here, yet...there are 8 DNS positions open and some in Assisted Living. The trend now is to put in an "interim" work her/him to death and then hire maybe in 6 months a real DNS, then that DNS gets fired, it's ridiculous. There for awhile, the survey WAS not an issue and DNS's stayed in buidlings for long periods of time, which resulted in beter and better surveys. BUT now it is QIS, and it's going back to the old way, fire and hire, fire and hire. It's very hard on the line staff, doesn't make for safe nursing care and is of no use to resident care, period. It defeats good care. It will take awhile for the pendulum to swing back to the correct focus, patient advocacy. Thanks very much for your kind words, very very much appreciated.